西藏地区病理诊断中枢神经系统病变的回顾分析

Retrospective Analysis of Pathological Diagnosis of Central Nervous System Diseases in Tibet

目的总结分析西藏地区经病理诊断的中枢神经系统(CNS)病变的病种谱系及临床病理特点。方法回顾性分析西藏自治区人民医院2013年1月至2020年12月所有经病理诊断为CNS病变的病例资料,通过光镜观察、免疫组织化学染色及特殊染色进行病理分析。结果本研究共纳入383例CNS病理诊断病例,男女比例为188∶195,平均年龄(40.03±17.39)岁(0~74岁)。其中,非肿瘤性疾病127例(33.2%),男女比例82∶45,平均年龄(31.99±19.29)岁;肿瘤性疾病256例(66.8%),男女比例为106∶150,平均年龄(44.01±14.87)岁。非肿瘤性疾病占比排名依次为神经系统感染性疾病、脑血管病、脑(脊)膜膨出、脑囊肿和脑外伤,在感染性疾病中依次为脑脓肿、肉芽肿性炎症、囊虫病和包虫病。肿瘤性疾病占比排名依次为脑膜瘤、垂体腺瘤、神经上皮源性肿瘤、神经鞘瘤、转移性肿瘤和血管母细胞瘤等。脑膜瘤中,95.4%(103/108)为Ⅰ级,3.7%(4/108)为Ⅱ级,0.9%(1/108)为Ⅲ级;神经上皮源性肿瘤中,前3位依次为胶质母细胞瘤、Ⅲ级弥漫型胶质瘤和室管膜瘤。结论西藏地区经病理诊断的CNS疾病病种多样,其中非肿瘤性疾病占到全部病例的1/3,感染性和血管性病变是最常见的非肿瘤性病变,结核病和寄生虫感染在当地相对常见。肿瘤性疾病类型和占比与我国其他地区不同,脑膜瘤最常见,其占比高于神经上皮源性肿瘤。

Objective To analyze the disease spectrum and clinicopathological characteristics of central nervous system(CNS)diseases diagnosed based on pathological findings in Tibet.Methods We collected the data of all the cases with CNS lesions in Tibet Autonomous Region People’s Hospital from January 2013 to December 2020.The clinicopathological features were analyzed via light microscopy,immunohistochemical staining,and special staining.Results A total of 383 CNS cases confirmed by pathological diagnosis were enrolled in this study,with a male-to-female ratio of 188∶195 and an average age of(40.03±17.39)years(0-74 years).Among them,127(33.2%)cases had non-neoplastic diseases,with a male-to-female ratio of 82∶45 and an average age of(31.99±19.29)years;256(66.8%)cases had neoplastic diseases,with a male-to-female ratio of 106∶150 and an average age of(44.01±14.87)years.The main non-neoplastic diseases were nervous system infectious diseases,cerebral vascular diseases,meningocele,cerebral cyst,and brain trauma.Among the infectious diseases,brain abscess,granulomatous inflammation,cysticercosis,and hydatidosis were common.The main neoplastic diseases included meningioma,pituitary adenoma,neuroepithelial tumor,schwannoma,metastatic tumor,and hemangioblastoma.The meningioma cases consisted of 95.4%(103/108)cases of gradeⅠ,3.7%(4/108)cases of gradeⅡ,and only 1(1/108,0.9%)case of gradeⅢ.Among the neuroepithelial tumor cases,the top three were glioblastoma,gradeⅢdiffuse glioma,and ependymoma.Conclusions There are diverse CNS diseases confirmed by pathological diagnosis in Tibet,among which non-neoplastic diseases account for 1/3 of all the cases.Infectious and vascular diseases are the most common non-neoplastic diseases in Tibet,and tuberculosis and parasitic infections are relatively common.The types and proportion of brain tumors in Tibet are different from those in other regions of China,and meningioma is the most common in Tibet,with higher proportion than neuroepithelial tumor.